S.S.

AGRAWAL COLLEGE OF NURSING

TRAINING COLLEGE AND RESEARCH
CENTER,NAVSARI.

SUB - MEDICAL SURGICAL NURSING

TOPIC – Case Study on POTT’S DISEASE

SUBMITTED TO, SUBMITTED BY,

MRS.POONAM PATEL MS AVNI PATEL
ASSO. PROFESSOR 2nd YEAR M.SC (N)
SSAGCON,NAVSARI SSAGCON,NAVSARI

DATE OF SUBMISSION

16-6-22

1
OUTLINE

 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Disease condition
 Anatomy and physiology
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography

2
INTRODUCTION

Name-Patel Avni c.

Class- First year M.sc Nursing

Topic- Medical case study on POTT’s Disease.

Date-16-6-22

Introduction

As a part of our clinical experience in medical surgical nursing ,we posted in

Navsari hospital and we posted for training.I selected one patient for my case
presentation requirement.

3
HISTORY COLLECTION

INFORMATION DATA
Name – Mr Maganbhai ManguBhai Ahir
Age – 57 year
Sex - Male
Address –udhyog nagar,Navsari
Date of birth -04/09/1969
Education-9th pass
Religion- Hindu
Bed number- 08
Ward- Male medical ward
Medical diagnosis- POTT’S DISEASE
Surgery- not performed
Occupation- worker
Date and time of admission-16-6-22

CHIEF COMPLAINT
Mr. Magan bhai is complaining of weakness of left leg
Since 1 & half month
fever
fatigue
Weakness
Difficuly in walking

4
HISTORY OF PRESENT MEDICAL ILLNESS
Mr.Magan lbhai having present complaints are:
 Weakness in left leg
 Walk for about 1- 2 minute
 Fever
 sweating
 abdominal jerking

HISTORY OF PRESENT SURGICAL ILLNESS

No any significant data about present surgical illness.
HISTORY OF PAST MEDICAL ILLNESS
Patient having history of low back pain since 2 years.& no any other history like,Anemia ,
seizures, arthritis,heart disorders.
Trauma , injury- no any significant data about trauma or injury .
Hospitalization- 2 -3 times patient admitted in the hospital for the treatment of the asthma.
Childhood diseases and immunization- No any significant data about childhood
disease,patient taken all the vaccine like,tetanus,hepatitis,mumps,rubella,pertusis.

FAMILY HISTORY

KEY

seemaben Maganbhai (52year) Male

(52 year)

Shrey (30 year) Fem Female

Patient

5
FAMILY COMPOSITION

Name of Ag sex Educatio occupatio Incom Relationshipwit Healt

the e n n e h pt h
family status
member
1.Maganbhai 57yr male 9th pass worker 10000 patient ill
i
2.seemaben 52yr femal illterate housewife - wife healthy
e
3.Shrey 30 yr male B.com clerk 1,20,ooo son healthy

FAMILY HISTORY
Mr.Anilbhai living in a nuclear family.no any hereditary disorder is present in the family
member .All the members are well cooperate with each other.
PERSONAL HISTORY
Mr Anilbhai is looking moderately nourished, skin colour is brown,he has a habit of
smoking.he is a vegetarian.in the routine food he takes dalroti,rice,sabji 2 times per day.
Personal hygiene:
Oral hygiene-once a time
Bath-once in a day daily
Sleep and rest- 7 hours/day
Elimination:
Bowel per day:regular per day
Urine frequency:1500ml/day
Mobility and exercise:
Moderate:moderate exercise he is doing.

ENVIRONMENTAL HISTORY:
Type of house: pacca
Ventilation:good
Water supply: municipality
Electricity: good
Drainage: closed drainage

6
Cooking:separate kitchen
Location of house: in village
Pet animals: No

PHYSICAL EXAMINATION

GENERAL HEALTH:
 Nourishment-poorly nourished
 Body built-normally built
 Health-ill
 Activity-dull
 Facial expression-dull
 Level of consciousness-conscious
Height-4 feet 6 inch
Weight-60kg
Temperature-99 degree c
Pulse-86 beats/min
Respiration-18 breath/min
Blood pressure-140/80mm/Hg

HEAD AND FACE:

 Hair-Black

7
  Scalp-dandruff present,no injury,
 Skull-normal in shape
 Face – slight edema
 Sinuses-no swelling,tenerness
EYES:
 Eye brow-symmetrical
 Eyelashes-no any infection
 Eye lid-no edema
 Eye ball-euqally reaction to the light
 Conunctiva-pale
 Sclera-whitish
 Lens-opaque
 Vision-normal
EAR:
 External ear- no discharge
 Tympanic membrane-normal
 Hearing acuity-normal
 Drainage from ear-no discharge ,pus
 Hearing aid-not used
NOSE:
 Location- centrally located
 Nasal deviation-not found
 Bleeding-no
 Patency of the nostrils-patented
 Condition of nasal mucosa-pale in colour
 Flaring nostrils-not presented
 Inflammation-not found
 Nasal polyps-not found
MOUTH:
 Lips-dry
 Oral cavity-pale mucous membrane of oral cavity
 Teeth-normal
 Tounge-slightly dry and coated tounge
 Vocal cord,uvula and tonsils-not enlarged and inflammed
 Speech disorder-not presented
NECK:
 Movement-full and smooth range of movement
 Jugular vein-not enlarged
 Condition of thyroid-no enlargement of thyroid gland

8
CHEST:
 Respiratory rate-18 breath/min
 Depth of respiration –normal depth
 Quality of respiration- dyspnoea in lying position
CHEST INSPECTION:
- Lateral diameter is wider than anterior posterior diameter
- Sternum is located at the midline
- Even expansion of the chest during breathing
- No intercostals retraction
CHEST PALPATION:
- No tenderness,lump or depression along the ribs.
Percussion
- Deep resonant sound heard all over the lungs.
Auscultation
- Breath sounds are heard in all areas of the lungs
- Inspiration longer than expiration
- No rhonchi,wheezing sounds was presented
HEART
 Pulse rate-82 beats/min
 Character of pulse-normal
 Blood pressure-140/80mm/hg
 Varicosities-absent
 Visible external jugular veins-absent
 Systolic or diastolic murmur-absent
ABDOMEN
 Size and shape of abdomen-normal size and shape
 Inspection-no lesion
 Palpation-no organomegaly
 Shifting dullness-absent
 Distended abdominal veins-absent
 Fluid thrill-absent
 Abdominal girth-34 inch
 Bowel sound-present

GENITAL AREA
 Lesion or tumors of rectal area-not found
 Abnormalities of genito urinary area-not found

9
EXTREMITIES
 Motor strength and mobility-slightly reduced
 Enlargement and stiffness of joint-not present
 Range of motion-passive

LOCAL EXAMINATION
 Look- Bulging in the middle of lumbar spine
 No scar mark
 Discharging sinus or pigmentation
 Feel- overlying skin is free
 Fullness of mid lumber region with spasm.
 Size –about 4cm
SYSTEMIC EXAMINATION
Locomotor system
 Gait-unable to walk
 Limb joints-normal
 Spinal movement- Restricted and painful
 Deformity-absent
COMFORT,SLEEP AND REST
 Location of pain-left leg

10
INVESTIGATION

CBC PROFILE
PARAMETER PATIENT VALUE
CBC
HB 12%
ESR 12omm/1st hour
WBC COUNT 11000/cmm
NEUTROPHIL 62%
LYMPHOCYTE 35%
EOSINOPHIL 02%
MONOCYTES 1%
RBS 13.6,g/dl
PUS CELL 01-03/HPF
S.CREATIINE 1.2mg/dl

CHEST X-RAY
Normal
ECG: Normal ECG finding
USG of whole abdomen-No itraabdominallymphadenopathy
SPECIFIC INVESTIGATION
MT-18MM
Anti TB-IgG,IgM,IgA:positive
X-RAY.L-S- SPINE BOTH VIEW:
Disc space between L4 &L5 and L5 & S1 is reduced with destruction of adjacent end plate.

11
No obvious para vertebral soft tissue swelling is noted.
MRI:
Tubercular spondylitis at L4 & L5 level with peri vertebral mass.
Vertebral posterior buldging causing indentation of thecal sac.
Disc space between L5&S1 is reduced.
Rt para-vertebral abscess.

PHARMACOLOGICAL MANAGMENT
Sr no Drug Name Dose Route Frequency Action
1 Rifampicin 600mg oral BD Antituberculi
2 Ethambutol 800mg oral OD Antituberculi
3 Pyrazinamide 15-30mg oral BD Antituberculi
4 Streptomycin 15mg oral OD Antibiotic
5 Isoniazid 5-15mg oral BD Antituberculi
6 Acetaminophen 650mg oral OD Antipyretic

12
13
Drug name Dose,route Mechanism of Indication contraindication Side effect Nursing
action responsibilities
Tab Acetaminophen 600gm The exact Backache -severe hepatic Severe diarrhoea -asess the
mechanism is Arthritis impairement . patient
Route unknown.it Toothache hypersensitivity Nausea. condition.
Oral may reduce Menstrual - monior the
Vomiting.
the cramps hemodynamic
production of Muscular Stomach pain. status
prostaglandid ache Itching or skin -assess for
in the brain. fever rash. allergic
Headache. reaction
Dizziness. -maintai IO
chart.
Fits.
-maintain
rights of
patients.

14
Drug Dose,route Mechanism Indication contraindicatio Side effect Nursing
name of action n responsibilitie
s
Tab 650gm Rifampin i Bacterial -severe hepatic Severe diarrhoea -asess the
Rifampici s thought to disorder impairement . patient
n Route inhibit hypersensitivity Nausea. condition.
Oral bacterial Tuberculosis - monior the
Vomiting.
DNA- . hemodynamic
dependent meningitis Stomach pain. status
RNA Itching or skin -assess for
polymerase, rash. allergic
which Headache. reaction
appears to Dizziness. -maintai IO
occur as a chart.
Fits.
result of -maintain
drug rights of
binding in patients.
the
polymerase
subunit
deep within
the
DNA/RNA
channel,
facilitating
direct
blocking of
the
elongating
RNA .

15
Drug name Dose,route Mechanism Indication contraindication Side effect Nursing
of action responsibilities
Tab 15-30mg Rifampin is Bacterial -severe hepatic Severe diarrhoea. -asess the
Isoniazid Route thought to disorder impairement Nausea. patient
Oral inhibit hypersensitivity condition.
Vomiting.
bacterial Tuberculosis - monior the
DNA- . Stomach pain. hemodynamic
dependent meningitis Itching or skin status
RNA rash. -assess for
polymerase, Headache. allergic
which Dizziness. reaction
appears to -maintai IO
Fits.
occur as a chart.
result of -maintain
drug rights of
binding in patients.
the
polymerase
subunit deep
within the
DNA/RNA
channel,
facilitating
direct
blocking of
the
elongating
RNA .

16
17
ANATOMY & PHYSIOLOGY

The spinal cord is a continuation of the brainstem. It extends from the foramen magnum at the
base of the skull to the L1/L2 vertebra where it terminates as the conus medullaris (medullary
cone). A thin thread called filum terminale extends from the tip of the conus medullaris all the
way to the 1st coccygeal vertebra (Co1) and anchors the spinal cord in place.

You can easy remember the extent of the spinal cord with a mnemonic 'SCULL', which stands
for ' Spinal Cord Until L2 (LL)'.

Throughout its length, the spinal cord shows two well defined enlargements to accommodate
for innervation of the upper and lower limbs: one at the cervical level (upper limbs), and one at
the lumbosacral level (lower limbs).

Like the vertebral column, the spinal cord is divided into segments: cervical, thoracic, lumbar,
sacral, and coccygeal. Each segment of the spinal cord provides several pairs of spinal nerves,
which exit from vertebral canal through the intervertebral foramina. There are 8 pairs of
cervical, 12 thoracic, 5 lumbar, 5 sacral, and 1 coccygeal pair of spinal nerves (a total of 31
pairs).

18
Functions

The spinal cord plays a vital role in various aspects of the body’s functioning. Examples of
these key functions include:

 Carrying signals from the brain: The spinal cord receives signals from the brain
that control movement and autonomic functions.

 Carrying information to the brain: The spinal cord nerves also transmit messages to
the brain from the body, such as sensations of touch, pressure, and pain.

 Reflex responses: The spinal cord may also act independently of the brain in
conducting motor reflexes. One example is the patellar reflex, which causes a
person’s knee to involuntarily jerk when tapped in a certain spot.

These functions of the spinal cord transmit the nerve impulses for movement, sensation,
pressure, temperature, pain, and more.

19
INTRODUCTION
Pott disease is tuberculosis of the spine,[1] usually due to haematogenous spread from other
sites, often the lungs. The lower thoracic and upper lumbar vertebrae areas of the spine are
most often affected.
It causes a kind of tuberculous arthritis of the intervertebral joints. The infection can spread
from two adjacent vertebrae into the adjoining intervertebral disc space. If only one vertebra
is affected, the disc is normal, but if two are involved, the disc, which is avascular, cannot
receive nutrients, and collapses. In a process called caseous necrosis, the disc tissue dies,
leading to vertebral narrowing and eventually to vertebral collapse and spinal damage. A dry
soft-tissue mass often forms and superinfection is rare.
Spread of infection from the lumbar vertebrae to the psoas muscle, causing abscesses, is not
uncommon.

DEFINITION
Pott disease, also known as tuberculous spondylitis, is a classic presentation of
extrapulmonary tuberculosis (TB). It is associated with significant morbidity and can lead to
severe functional impairment.

CAUSES

Bone TB occurs when you contract tuberculosis and it spreads outside of the lungs.
Tuberculosis is normally spread from person to person through the air. After you contract

20
tuberculosis, it can travel through the blood from the lungs or lymph nodes into the bones,
spine, or joints. Bone TB typically begins due to the rich vascular supply in the middle of the
long bones and the vertebrae.

Bone tuberculosis is relatively rare, but in the last few decades the prevalence of this disease
has increased in developing nations partially as a result of the spread of AIDS. While rare,
bone tuberculosis is difficult to diagnose and can lead to severe problems if left untreated.

BOOK PICTURE CLIENT PICTURE

Inflammatory edema
Tuberculous abscess
Cord constriction
Vertebral canal stenosis -
Infective thrombosis
TB

STAGES

21
22
PATHOPHYSIOLOGY
Phagocytosis of tubercle bacilli by RES,( monocytes,macrophages)

Tuberculous granulomas( Langhans giant cells)

Small patches of central caseous necrosis

Coalesce into a large yellow mass

Breakdown of center to form cold abscess.

23
CLINICAL MANIFESTATION

BOOK PICTURE CLIENT PICTURE

Soft and smooth mass present
Incidious in onset
Soft and smooth mass present
Cystic consistency
Flactuation present
Slip sign negative
No transillumination
Progressive back pain

DIAGNOSTIC EVALUATION

The Mantoux Test (Tuberculin Skin Test)

Injection of a purified protein derivative (PPD). Results are positive in 84-95% of patients
with Pott’s disease who are not infected with HIV.

Erythrocyte Sedimentation Rate (ESR)

ESR may be markedly elevated (>100 mm/h)

Microbiology Studies
Microbiology studies are used to confirm diagnosis. Bone tissue or abscess samples are
obtained to stain for acid-fast bacilli (AFB), and organisms are isolated for culture and
susceptibility. CT-guided procedures can be used to guide percutaneous sampling of affected
bone or soft tissue structures; however, these study findings are positive in only about 50% of
the cases.

Radiography
Radiographic changes associated with Pott’s disease present relatively late. The following are
radiographic changes characteristics of spinal tuberculosis on plain radiography:

24
 Lytic destruction of anterior portion of vertebral body
 Increased anterior wedging
 Collapse of vertebral body
 Reactive sclerosis on a progressive lytic process
 Enlarged psoas shadow with or without calcification
 Vertebral end plates may be osteoporotic
 Intervertebral disks may be shrunk or destroyed
 Vertebral bodies show variable degrees of destruction
 Fusiform paravertebral shadows suggest abscess formation
 Bone lesions may occur at more than one level[1]
CT Scanning
CT scanning provides much better bony detail of irregular lytic lesions, sclerosis, disk
collapse, and disruption of bone circumference. Low contrast resolution provides a better
assessment of soft tissue, particularly in epidural and paraspinal areas. CT scanning reveals
early lesions and is more effective for defining the shape and calcification of soft tissue
abscesses which is common in TB lesions.

MRI
MRI is the criterion gold standard for evaluating disk-space infection and osteomyelitis of the
spine and is most effective for demonstrating the extension of disease into soft tissue and the
spread of tuberculous debris under the anterior and posterior longitudinal ligaments. MRI is
also called the most effective imaging study for demonstrating neural compression. MRI
findings useful to differentiate tuberculosis spondylitis from pyogenic spondylitis include thin
and smooth enhancement of the abscess wall and well-defined paraspinal abnormal signal,
whereas thick and irregular enhancement of abscess wall and ill-defined paraspinal abnormal
signal suggest pyogenic spondylitis. Thus, contrast-enhanced MRI appears to be important in
the differentiation of these two types of spondylitis.

25
 MRI of the thoracic spine (T2-weighted, sagittal reconstruction). The dorsal fluid
collection suggests a

paravertebral abscess (large arrow) just above the fractured and operated third thoracic
vertebra (small arrow)

Biopsy
Use of a percutaneous CT-guided needle biopsy of bone lesions can be used to obtain tissue
samples. This is a safe procedure that also allows therapeutic drainage of large paraspinal
abscesses.

Polymerase Chain Reaction (PCR)

PCR techniques amplify species-specific DNA sequences which is able to rapidly detect and
diagnose several strains of mycobacterium without the need for prolonged culture. They have
also been used to identify discrete genetic mutations in DNA sequences associated with drug
resistance

MEDICAL MANAGEMENT

The duration of treatment is somewhat controversial. Although some studies favor 6 to 9

month course, traditional courses range from 9 months to longer than 1 year. The
duration of therapy should be individualized and based on the resolution of active
symptoms and the clinical stability of the patient. [1]

The main drug class consists of agents that inhibit growth and proliferation of t stance

Isoniazid (Laniazid, Nydrazid)

Highly active against Mycobacterium tuberculosis. Has good GI absorption and
penetrates well into all body fluids and cavities.

Rifampin (Rifadin, Rimactane) For use in combination with at least one other
antituberculous drug; inhibits DNA-dependent bacterial but not mammalian RNA
polymerase. Cross-resistance may occur.

Pyrazinamide
Bactericidal against M tuberculosis in an acid environment (macrophages). Has good
absorption from the GI tract and penetrates well into most tissues, including CSF.
Ethambutol (Myambutol)
Has bacteriostatic activity against M tuberculosis. Has good GI absorption. CSF
concentrations remain low, even in the presence of meningeal inflammation.

26
Streptomycin
Bactericidal in an alkaline environment. Because it is not absorbed from the GI tract,
must be administered parenterally. Exerts action mainly on extracellular tubercle bacilli.
Only about 10% of the drug penetrates cells that harbor organisms. Enters the CSF only
in the presence of meningeal inflammation. Excretion is almost entirely renal.
he causative bacteria. Isoniazid and rifampin should be administered during the whole
course of therapy. Additional drugs are administered during the first two months of
therapy and these are generally chosen among the first-line drugs which include
pyrazinamide, ethambutol, and streptomycin. The use of second-line drugs is indicated in
cases of drug resi

Book picture Client picture

Isoniazid 
Rifampicin 
Ethambutol 
streptomycin 
pyrazinamide 

SURGICAL MANAGEMENT

 Anti-Tuberculosis Chemotherapy
 Surgical Drainage of Abscess
 Surgical Spinal Cord Decompression
 Surgical Spinal Fusion
 Spinal Immobilization
Predictors of Good Prognosis

 Partial Cord Compression

 Short Duration of Neural Complications
 Early Onset Cord Involvement with Delayed Neural Complications
 Young Age
 Good General Condition
Effective chemotherapy for Pott’s disease is the gold standard and must be started at the
early stages of the disease. Radical ventral debridement, fusion and reconstruction of the
vertebral column remains the gold standard of surgical treatment for tuberculosis
spondylitis.

Multiple surgical approaches have been conducted to correct the spinal deformity seen in
Pott's disease with varying results. Laminectomy failed to address the anterior
component of the disease process and spinal instability. Posterior fusion has been
successful at reducing kyphosis but preoperative infection and high levels of kyphosis
have resulted in many fusion failures. An anterior approach, used by Hodgson and
Stock, has also been used with great success.

27
Various surgical techniques are utilized based on which area of the spine is affected. In
the upper cervical spine, a transoral or extreme lateral approach is taken which typically
requires concurrent occipito-cervical fusion to prevent collapse, instability and delayed
deformity. Midcervical lesions are often treated with standard anterior cervical
approaches and achieve excellent results. Transsternal, transmanubrial, or lateral
extracavitary approaches are conducted in patients with involvement of the lower
cervical/upper thoracic spine. In the thoracic spine surgeons make use of transthoracic,
extraplural anterolateral or extended posterolateral approaches. The posterolateral
method ismore often utilized in severe cases of kyphosis due to the natureof the spinal
deformity and ease of access to the spine. However, surgical correction of a severe
kyphotic deformity (>30 degrees) will often require a posterior technique that is complex
and technically demanding. Surgical morbidity and mortality can be significant for these
technically demanding procedures with ;an 8-10% incidence post correction neurological
complications. Surgical procedures in the lumbar spine are typically performed through a
lateral retroperitoneal approach which is the preferred method compared to an anterior or
retroperitoneal procedure.

Surgery done during the active course of the disease is much safer with a faster and
better response. Moreover, the importance of early diagnosis, start of appropriate
treatment and its continuation for adequate duration along with the proper counseling of
the patient and family members with the timely surgical intervention is the key for the
success in achieving a good outcome.

Physical Therapy Management (current best evidence)

Patients with Pott's disease often undergo spinal fusion or spinal decompression
surgeries to correct their structural deformity and prevent further neurological
complications. There are no established guidelines which dictate treatments that will
yield positive outcomes in such patients. However, treatment regimens should address
each patient individually, focusing on any impairments, functional limitations and/or
disabilities with which they present.

PT Managment Post-Spinal Decompression Surgery

 Spinal Stabilization Exercises

 Maitland
 Back School
 Exercise and Strengthening
When compared with other physical therapy treatments and self-managment, spinal
stabilization exercises were found to produce significantly more positive ratings in
global outcomes. Pain and disability, however, did not show significant improvement
when compared to the other two treatment options.

PT Managment Post-Spinal Fusion Surgery

 TENS (Transcutaneous Electrical Neuromuscular Stimulation)

 Aquatic Therapy
 Overground Training (Walking Program)

28
 Aerobic Exercise
 Trunk Strengthening
Studies examining the use of TENS have shown higher frequencies are more effective in
decreasing neuropathic pain. Aerobic exercise, PT, and trunk strengthening interventions
have all attained significant decreases in pain, psychological distress and disability.

NURSING THEORY

 Roy adaptation
 Orem self-care deficit theory
 Abdellah theory
 Hendersons theory

THEORY APPLICATION

Mr. Maganbhai is having weakness, constipation, decreased urine output and difficulty in
walking & breathing difficulty and unable to do his daily activity so I’m going to apply to
orems self care deficit theory on patient care
INFORMATION DATA

Name – Mr Maganbhai ManguBhai Ahir

Age – 57 year
Sex - Male
Address –udhyog nagar,Navsari
Date of birth -04/09/1969
Education-9th pass
Religion- Hindu
Bed number- 08
Ward- Male medical ward
Medical diagnosis- POTT’S DISEASE
Surgery- not performed
Occupation- worker
Date and time of admission

ASSUMPTIONS

29
  Human beings require continuous ,deliberate inputs to themselves and their
environment to remain alive and function according to their capacity.
 Human agency is exercised in the form of care for self and others in identifyig and
meeting needs.
 Mature human beings experience privations in the form of limitations for action and
care for of clustered tasks and alloself and others involving life sustaining and
function regulating inputs.
 Human agency is exercised in discovering developing and transmitting ways and
means to identify needs and make input to self and others.
 Groups of human beings with structured relationship of clustered tasks and allocate
responsibilities for providing care to group members who experience privations for
making required deliberate input to self and others.

PRIORITY OF NURSING PROBLEM ACCORDING TO OREMS THEORY OF

SELF CARE DEFICIT

 Prevent or manage the development threats

 Maintenance of health status
 Awareness and management of the disease process
 Adherence to the medical regimen
 Awareness of potential problem
 Modify self image
 Adjust life style to accommodate health status changes

UNIVERSAL SELF CARE REQUISITES

 Air : Breath without difficulty,no pallor cynosis
 Water:Fluid intake is sufficient .Edema present over ankles.Turgor normal for the age.
 Food: Food intake is not adequate
 Elimination: Voids and elimination bowel without difficulty
 Activity/Rest: Frequent rest is required due to pain.
Pain not completely relieved.
Activity level has come down.
 Social interaction: Communicate well with neighbours and calls the daughter by
phone,need for medical care is communicted to the daughter.
 Prevention of hazards: Need instruction on care of joints and prevention of falls.
Need instruction on improvement of nutritional status.
 Promotion of nonmalcy:Has good relation with daughter.

30
 NURSING PROCESS

NURSING DIAGNOSIS
1.Chronic pain related to inflammatory process as evidenced by refusal or inability to
participate in ongoing exercise or rehabilitation programme.
2. Impaired physical mobility related to restricted joint movement as evidenced by decreased
muscle strength.
3.Activity intolerance related to decrease muscle tone as evidenced by limitation of
movement.
4.Self care deficit related to musculoskeletal impairement decreased strength/endurance as
evidenced by inability to manage their self care activities.
5.Deficient knowledge related to information misinterpretation as evidenced by inaccurate
follow through of instructions.
6.Risk for injury related to altered mobility

31
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Chronic pain Client will report Assess the Assessed the patient
After providing all the
patient says,” I’m related to joint satisfactory pain patient pain level. pain level by pain
nursing care clients
degeneration as control. scale. (6/10) level of pain will be
having pain
evidenced by reduce some extent.
extremities. refusal or inability Provide comfortable
to participate in position to the Provided semi fowler
ongoing exercise patient. position to the patient.
or rehabilitation
Objective data: programme

By pain scale Provide comfort Provided hot

device position to the application to the
6/10 patient. patient for reduce

Provide diversional Provided music

therapy to the patient therapy to the patient.

Administer Administer analgesic

medication as per (Inj,Ibuprofen), 75mg,
doctors order. iv as per doctors order.

32
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Impaired physical Client will Assess the Assessed the patient
After providing all the
patient says,” I’am mobility related to perform physical patient posture pain level by pain
nursing care clients
restricted joint activity and gait. scale. (6/10) physical mobility
not able to do my
movement as independently improve some what..
work evidenced by Provided semi fowler
decreased muscle Assess range of motion position to the patient.
strength. in all joints
Encouraged siting in a
Objective data: chair with a raised seat
Encourage siting in a
and firm support
chair with a raised
By physical
seat and firm support
Encouraged the client to
examination ambulate with assisitvie
Encourage the client to device
ambulate with assisitvie
(impaired device

Administerd analgesic
mobility) Administer
(Inj,Ibuprofen), 75mg,
medication as per
iv as per doctors order.
doctors order.

33
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Activity Client will report Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I’am intolerance related a measureble
nursing care clients
to decrease muscle increase in mobility of the client. mobility of the client.
not able to do my activity level improve
tone as evidenced activity somewhat.
work by limitation of intolerance. Assess the need for Assessed the need for
movement. ambulation aids ambulation aids

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By physical
Encourage active Encouraged active
examination range of motion range of motion
exercise exercise

(Activity level)
Assess the clients Assessed the clients
nutritional status nutritional status

34
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Self care deficit related Client will Assess the physical Assessed the physical
activity level and activity level and After providing all the
patient says,” I’am to musculoskeletal demonstrate
nursing care clients
impairement decreased technique mobility of the client. mobility of the client.
not able to do my strength/endurance as activity level improve
changes to meet somewhat.
work evidenced by inability self care needs Assess the need for Assessed the need for
to manage their self ambulation aids ambulation aids
care activities.
Encourage the client to Encouraged the client to
Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By physical
Allow patient Allowed patient
examination sufficient time to sufficient time to
complete tasks to complete tasks to
the fullest extent the fullest extent of
(Musculoskeleta of ability. ability.

l examination)
Consult with Consuletant with
rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)

35
ASSESSMENT NURSING OBECTIVES NURSING IMPLIMENTATION EVALUATION
DIAGNOSIS INTYERVENTION

Subjective data: Deficient knowledge Client will Assess the physical Assessed the physical
activity level and activity level and After providing
patient says,” I don’t related to information verbalize
knowledge about
misinterpretation as understanding of mobility of the client. mobility of the client.
know how this evidenced by condition client get
conditions/progno somewhat knowledge
disease occur inaccurate follow sis, and potential Assess the need for Assessed the need for regarding disease
through of instructions. complications. ambulation aids ambulation aids condition.

Encourage the client to Encouraged the client to

Objective data: ambulate with assisitvie ambulate with assisitvie
device device
By asking
Allow patient Allowed patient
frequent sufficient time to sufficient time to
complete tasks to complete tasks to
question. the fullest extent the fullest extent of
of ability. ability.

Consult with Consuletant with

rehabilitation rehabilitation
specialist( occupat specialist( occupati
ional therapist) onal therapist)

36
37
DIET

Increase Fluid Intake

One of the biggest problems in POTS is the inability to tolerate standing, due to blood
pressure dropping and heart rate increasing. Part of the typical initial POTS treatment strategy
is increasing water intake.

Water intake has been shown to help healthy people tolerate standing for longer, and be less
likely to faint in response to prolonged standing (Lu et al). Water intake has also been shown
to be beneficial in patients with orthostatic syndromes (Shannon et al). Most these studies
examine the effect of drinking about ½ a liter of water over a five-minute period. Effects
include improvement in standing blood pressure and reduction in standing heart rate, in
addition to improvement in symptoms. In POTS patients, the fluid intake doesn’t have to be
water to be effective. Soup was also shown to result in improvement of the blood pressure
response and also in symptoms (Z’Graggen et al). This suggests that as long as hydration is
maintained, it doesn’t matter too much what the fluid is.

A study done in 1999 looked in to one of the ways this actually worked (Jordan et al). It was
found that it stimulated the sympathetic nervous system and raised the level of the
stimulatory neurotransmitter norepinephrine, helping to maintain blood pressure.

Increase Salt Intake

There is typically a recommendation to increase salt intake in POTS syndrome, even to

increase sodium intake to 5-10g/day for very symptomatic patients. Others would generally
advise that salt intake is increased by 2-4g/day. There are dietary ways to do this, and if salt
can’t be increased adequately through diet then salt tablets may be used if advised by a
doctor. Salt should of course be avoided in those with kidney disease or heart failure.

Usually this is added to meals to achieve increased intake. One tablespoon of salt contains
between 2 – 2.5g of sodium. When salt tablets are used, they may cause symptoms such as
nausea and coated tablets may therefore be preferred. Salt supplementation is most likely
helpful if combined with a gradual exercise program .

38
Lower Carbs and Smaller Meals

POTS patients are generally advised to eat smaller meals more often rather than larger meals,
and also to limit the carbohydrate in their diet.

POTS patients may complain of worsening of their orthostatic symptoms after a meal. But
why is this? When a meal is eaten, there is increased blood flow to the digestive system in
order to help the digestion process. In POTS there is already a problem with blood pooling in
the lower part of the body, and not being returned to the heart or upper body as usual. So
when a large meal is eaten, there is an added stress of a large amount of blood being diverted
to the digestive system, and resulting pooling of blood in the vessels that supply the digestive
system (Jensen et al). Eating too fast may also contribute.

There is also evidence that the higher the carbohydrate content of a meal, the greater the
lowering of blood pressure in patients with orthostatic symptoms. The blood pressure was
seen to be higher in those that limited carbohydrate content in their meals.

Limiting or Avoiding Alcohol Intake

POTS patients are typically advised to stop drinking alcohol, or strongly limit its intake. Lets
take a look at the evidence underlying this recommendation.

Alcohol use has been related to passing out spells even in healthy young adults (Dermksian G
et al.). Alcohol use is also associated with impairment of the body’s usual response to
regulating blood pressure when standing. A nicely done study (Narkiewicz et al.) showed that
this is because alcohol use prevents blood vessels tightening as usual, stopping the return of
the blood to the upper body and the head. This may lead to low blood pressure, dizziness and
possibly passing out. Often the muscles, especially in the lower body, tighten in an effort to
increase blood flow return to the heart in response to a lower blood pressure. There is also

39
evidence that alcohol use blunts this muscle response (Carter et al) which may also explain
the worsening of orthostatic symptoms with alcohol use.

COMPLICATION

SUMMARY

40
In this assignment I had include the following topic:

 Introduction
 History collection
 Physical Examination
 Investigation
 Pharmacological management
 Disease condition
 Anatomy and physiology
 Introduction
 Definition
 Causes
 Risk factor
 Types
 Pathophysiology
 Sign & symptoms
 Diagnostic evaluation
 Medical management
 Surgical management
 Diet
 Nursing management
 Theory application
 Complication
 Nursing process
 Complication
 Health education
 Summary
 Conclusion
 Bibliography

Conclusion

41
Pott disease, also known as tuberculous spondylitis, is a classic presentation of
extrapulmonary tuberculosis (TB). It is associated with significant morbidity and can lead to
severe functional impairment.
The diagnosis tends to be delayed because of a nonspecific initial early manifestations and/or
low degree of suspicion. The diagnostic approach needs to be based on chronic pain or
deformity, epidemiological considerations, imaging, and adequate procedures to obtain
samples for bacteriological, pathological, or molecular confirmation.

BIBLIOGRAPHY

42
1. lewis’s medical surgical nursing,second south asia edition ,new delhi,reed
elsevier india pvt,ltd ,page num 587-628.

2.Brunner and suddharths textbook of medical surgical nursing,twelth

edition,new delhi,page num,602-619.

3. Black J.M & Matassarin E(1997),MEDICAL SURGICAL NURSING:Clinical

Management for continuity of care.J.B.Lippincott.co

4. Smeltzer S.C.&Bare,B(2003) BRUNNER & SUDDARTHS TEXTBOOK OF

MEDICAL SURGICAL NURSING (10th edition).

5. Brunner & siddharts, ‘’ TEXTBOOK OF MEDICAL SURGICAL NURSING’’

Jaypee Brothers medical publishers(p) LTD,13th edition

6 F.A.Davis,”DRUG GUIDE FOR NURSES,” 9th edition, Nursing Robert Martone

Publication.

7.Javed Ansari and Davinder Kaur, ‘’TEXTBOOK OF MEDICAL SURGICAL

NURSING- 1’’, first edition, pee vee publication, 2015

8.Ksum Samant,"MEDICAL SURGICAL NURSING," 3rd edition, Vora medicak

Publication.

9.Kochuthresiamma Thomas," MEDICAL SURGICAL NURSING -I," 1st edition,

Jaypee publication.
10.Ross and Wilson’’ANATOMY AND PHYSIOLOGY,” 12TH edition, jaypee
Publication.

43